NOT A REMOTE POSITION

Provider Negotiations Specialist Summary of Duties

The Provider Negotiations Specialist focus on reviewing medical bills/documentation and negotiating cost effective single case prospective and retrospective agreements with out-of-network Providers (i.e. physicians, healthcare facilities, and ancillary providers).

Essential Job Functions for a Provider Negotiations Specialist

Work collaboratively with Prime Corrections on cases where medical bills for inmates are determined to need a Single Case Agreement (SCA) or to be negotiated
Collaborate with Customer Relations on cases where medical bills for members are determined to need a Single Case Agreement (SCA) or to be negotiated
Develop, coordinate, and complete analysis of medical bills and documentation to ensure timely review and preparation of single case payment arrangements
Performs contract recruitment, negotiations, and renegotiations of assigned Core contract targets and any other special contract projects as assigned
Establishes and maintains positive relationships with Providers and their Business Office Manager

Education and other Qualifications for a Provider Negotiations Specialist

Bachelor's degree in business or a health-related field of study from an accredited college or university with
2 years of work experience in healthcare, insurance, claims processing, and medical billing/pricing; Prior experience as a Case Manager or Utilization Review Manager is preferred
Understand payment methodologies (i.e., APR DRG, MS DRG, APGs, APCs, RBRVS, Per Diems)
Prior experience in managed care contracting/negotiations and claims resolution are preferred
Demonstrated proficiency in Microsoft Office (Excel, PowerPoint, Word, MS Teams) is required

Competencies for a Provider Negotiations Specialist

Detailed focused and organized with effective time management / follow-up/follow through skills
Ability to work in a fast paced, changing environment; flexible to meet business needs
Results driven collaborator with a proven history of leading, mentoring, and training others
Ability to maintain confidential information; excellent communication skills (oral and written)
Superb critical thinking skills and the ability to persuade / influence others

Benefits

Medical Insurance (high deductible plan with an HSA)
Dental Insurance
Vision Insurance
Short-term and long-term disability paid by the company
Group term life paid by the company
PTO - 160 hours (4 weeks) with the ability to roll over 40 hours and cash out 40 hours at the end of the year
Fitbit program with monetary rewards
Employee recognition programs with monetary rewards
Corporate office amenities - specialty coffee machines, assorted tea options, smoothie bar, collaborative workspaces, fruit provide by company and an onsite market
Regular employee events such as potlucks, video game tournaments, door decorating contests, Mental Health Awareness Month activities, and a company carnival just to name a few of our past events

About Us

Prime Health Services (PHS) is a national medical cost containment company with a noteworthy PPO Network used by insurance carriers, TPA's, self-insureds, and governmental entities. Our tech-focused nature allows clients to take advantage of the flexibility of customization while not compromising on bill processing speed. Since 2001, we have specialized in medical provider network development and offer clients a tailored approach to medical cost containment: quality health care at discounted rates.

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Prime Health Services, Inc.

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Prime Health Services, Inc. | Provider Negotiations Specialist - Not Remote